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NMS Diagnosis > Exam 1- NMS General Info > Flashcards

Exam 1- NMS General Info Flashcards

1
Q

What can static palpation find?

A

Structural abnormalities, landmarks, soft tissue path

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2
Q

What can motion palpation find

A

Fixation (restriction)

Also ligament laxity from excessive joint play

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3
Q

Muscle test scale ranges from..?

A

0-5

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4
Q

Name the Muscle test rating:

No muscle movement, no joint movement (paralysis)

A

0/5

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5
Q

Name the Muscle test rating:

Full range of motion but not against gravity

A

2/5

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6
Q

Name the Muscle test rating:

Full range of motion against some resistance

A

4/5

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7
Q

Name the Muscle test rating:

Visible muscle movement, but no joint movement (twitch)

A

1/5

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8
Q

Name the Muscle test rating:

Full range of motion against full resistance

A

5/5

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9
Q

Name the Muscle test rating:

Full range of motion against gravity, but not against resistance

A

3/5

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10
Q

DTR Scale goes to..?

A

0-5+

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11
Q

Name the DTR Grading scale…

Hyperactive without clonus (hyper-reflexive)

A

3+

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12
Q

Name the DTR Grading scale…

Hypoactive reflex (hypo-reflexive)

A

1+

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13
Q

Name the DTR Grading scale…

Hyperactive w/ sustain clonus

A

5+

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14
Q

Name the DTR Grading scale…

Absent reflex

A

0

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15
Q

Name the DTR Grading scale…

Hyperactive w/ intermittent clonus

A

4+

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16
Q

Name the DTR Grading scale…

Normal “equal bilateral” reflex

A

2+

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17
Q

What is clonus??

A

A form of movement marked by contractions and relaxations of a muscle, occurring in rapid succession seen with, among other conditions, spasticity and some seizure disorders.

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18
Q

Sensory (dermatome) grading scale…

Absent sensation

A

Anesthesia

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19
Q

Sensory (dermatome) grading scale…

Equal sensation bilaterally

A

Normal

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20
Q

Sensory (dermatome) grading scale…

Decrease sensation

A

Hypoesthesia AKA Hypesthesia

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21
Q

Sensory (dermatome) grading scale…

Increase sensation

A

Hyperesthesia

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22
Q

Exam technique for CN I (olfactory)

A

Testing 1 nostril at a time, use non-irritating stimulant. Pt should be able to smell each side

Cloves ideal- can use soap, toothpaste or perfume

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23
Q

Unilateral loss of smell in CN I testing could mean what?

A

More likely significant- may Imply a structural brain lesion affecting the olfactory bulb or tract.

Could also be due to local causes (deviated septum, or blocked nasal passage)

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24
Q

Bilateral loss in CN I testing could imply what?

A

Rhinitis

Or damage to cribiform plate

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25
Q

CN II (optic nerve) exam technique for visual acuity

A

Each eye tested separately

Test best corrected vision using eyeglasses

Any pt with uncorrected visual acuity of less than 20/20 should be examined w/ a pinhole. Improvement of vision through a pinhole indicated that the error is refractive

Test distant vision using a snellen chart at 10 or 20 feet

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26
Q

How do you check peripheral visual field when testing CN II?

A

Wiggling fingers

Counting fingers

White pin

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27
Q

How do you test central visual field when testing CN II?

A

Red pin

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28
Q

Exam technique for CN II visual fields

A

Assessed by confrontation, i.e the examiner compares the pts visual field to their own and assumes that theirs is normal

1st test each eye separately

Test both eyes together w/ wiggling fingers

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29
Q

Review slides 14 and 15 for test

A

Slides 14 and 15

30
Q

The normal monocular visual field extends approx _____ degrees laterally
___ degrees medially
___ degrees superiorly
____ degrees inferiorly.

It is divided into _______ and ____ halves and _____ and ____ halves.

A

100

60

60

75

Nasal and temporal

Superior and inferior altitudinal

31
Q

A blind spot is located ____ degrees ____ to fixation and just below the:

A

15

Temporal

Horizontal meridian

32
Q

Light entering the eye travels along the ____ nerve to the ____ region of the _____ to cause pupillary constriction through the ____ ____ and ___ ____ nerve components of the _____ ____ nerve.

A

Optic

Pretectal

Midbrain

Visceral motor

Short ciliary

Ocular motor

33
Q

Exam technique for CN II- pupillary light reflex/eyelid elevation

A

Observe for ptosis

Observer pupils for size

Observe for any irregularities or asymmetry

34
Q

Review slide 19 and 20 for CN II Pupillary light

A

Slide 19 and 20

35
Q

Abnormal response for CN II pupillary light reflex/eyelid elevations

A

Ptosis is present

If eyelid covers part of all of the pupil when looking directly ahead

36
Q

CN III (oculomotor), IV (trochlear) and VI (abducens)

Extraocular movement exam technique

A

Examiner places themselves approx 1 meter in front of the pt

Ask pt to look each side, up and down following an H pattern

Pursuit: ask pt to follow a target (finger or pen) with eyes w/out moving their head

Pause at ends of gaze to observe for nystagmus

37
Q

How would you assess for saccadic eye movements

A

Have the pt make quick horizontal and vertical eye movements

38
Q

How is optokinetic nystagmus performed

A

By having the pt follow a series of moving horizontal/vertical stripes and observing for nystagmus

39
Q

How to test light touch for CN V

A

Light tough with a cotton wisp

If pt complains of sensory symptoms, it is advisable to perform side to side comparisons moving from the impaired side to the normal side

40
Q

CN V Trigeminal light touch examination technique

A

Touch a cotton wisp to forehead, cheek and chin

Use the pin to test for pain and tuning fork to test for cold

41
Q

The corneal reflex allows what?

A

An objective assessment of facial sensation.

Afferent Limb is V1 of the trigeminal nerve

42
Q

Review slide 27 and 28 for exam technique of corneal reflex and pain and them . Too much to types

A

Slide 27 and 28

43
Q

What does the mental status exam test?

A

State of consciousness

Orientation

Ability to cooperate

Mood

Thought process

Memory for recent and remote events

Ability to handle concepts and proverbs

Practical skills

Speech problems and recognition of aphasia

44
Q

Components of the sensory exam

A

Dorsal column systems

Lateral spinothalamic tract

Ventral spinothalamic tract

Spinocerebellar tract

Double simultaneous stimuli (extinction)

45
Q

The dorsal column systems consists of:

A

Fasciculus gracilis and cuneatus

46
Q

Function of the dorsal column systems

A

Fine touch (graphesthesia and stereognosis)

Vibration sense

2 point discrimination

47
Q

Function of lateral spinothalamic tract

A

Pain and temp

48
Q

Function of ventral spinothalamic tract

A

Pressure and crude touch

49
Q

Function of spinocerebellar tract

A

Coordination

50
Q

Sensory exam technique

A

Begin distally and move proximally- avoid calloused area

Compare rt-lt

Assess for a sensory level, peripheral nerve or dermatomal sensory impairment

51
Q

Dorsal column (light touch) exam technique

A

Use a cotton wisp

Apply gentle touch

Ask pt to close eyes and report “yes” every time they perceive the stimulus

52
Q

Pain (lateral spinothalamic tract) exam technique

A

Use disposable pin

Ask pt to Close their eyes and report whether they feel sharp or dull

Apply the short stimulus to all sites since if only the dull stimulus is applied, pain sensation has not been assessed.

53
Q

Temperature (lateral spinothalamic tract_ exam technique

A

Use cold vibration fork

Ask pt if the perceive fork as cold.

54
Q

Vibration sense exam technique

A

Use 128 hertz vibration fork

Apply stimulus over distal phalanx of index finger or large toe

Ask pt to report whether they feel vibration sense and then to report when it stops in order to assess the minimal threshold to perceive the stimulus.

Compare to your own extremities

55
Q

Position sense exam technique

A

Demonstrate to the pt initially w/ eyes open that you will be moving their digit up or down

Ask pt to close eyes

Stabilize distal interphalangeal joint of the upper extremity and make minimal movements upwards or downwards and ask pt to report after each movement the direction.

Similarly in lower extremities, stabilize the interphalangeal joint and move large toe up or down.

56
Q

Coordination (spinocerebellar tract) exam technique — upper extremities

A

Finger to nose

Rapid index to thumb movements or individual digits to thumb, rapid small index finger sircles over the opposite dorsal webspace, rapidly alternate each hand palmer then dorsal aspect down over thigh or opposite hand

57
Q

Coordination (spinocerebellar tract) exam tech for lower extremities

A

Ask pt to place their heel on their opposite knee and slide their heel down shin to ankle

Ask pt to tap their opposite knee with their heel

Have pt reach for your finger w their large toe

Ask pt to perform rapid foot taps

58
Q

What test is this?

Have pt flex their shoulder to 45 degrees and elbow to 90 degrees and make a fist. Then grab the fist and try to extend the elbow while the pt resists. Let go and see if the pr can stop from hitting themselves.

A

Steward Holmes rebound test

59
Q

2 point discrimination exam tech

A

Use either calipers or a opened paper clip w/ 2 parallel ends

Demonstrate to the pt w/ eyes open by applying either 1 or 2 points of the stimulus to the fingerpad

Ask pt to close their eyes

Deliver stimulus and ask pt to report if they feel 1 or 2 points

60
Q

Normal response of 2 pt discrimination?

A

Normal values over fingerpads are 2-4 mm

61
Q

Which exam technique is this?

Drawing something in the pts palm with your finger— a number, for ex.

Ask pt to close their eyes and identify it

A

Graphesthesia

62
Q

What is tested with this exam:

Place an item in the pts hand w/ their eyes closed. Ask them to feel it and identify it.

(Use coins, a key, safety pin, paper clips, etc)

A

Stereognosis

63
Q

What does Romberg’s test test?

A

Eyes
Ears
Dorsal Column

(Tests all 3 when eyes are open. When closed, only tests ears and DC)

64
Q

What test is this?

Pt stands in anatomical position with legs tight together with eyes closed.

Should be able to maintain balance

A

Romberg’s test

65
Q

Extinction (double simultaneous stimuli) exam technique - Tactile (sensory)

A

w/ eyes closed, touch pt on left side, right side, or both. Have pt report which side they feel it on.

should only be done if the pt can perceive a unilateral stimulus

66
Q

Visual extinction exam:

A

Wiggle a finger to the left, right, or both visual fields an ask the pt to report where they see it

67
Q

Auditory extinction test

A

Snap fingers on the left, right or both sides and have pt report where they hear the stimulus

When testing for extinction, it is important to deliver bilateral stimuli simultaneously w/ no time lag in between

68
Q

What test is this:

Use sharp edge of reflex hammer and stroke the bottom of the pt’s foot frmo heel up the lateral foot to the little toe across the ball of the foot to the big tow

A

Babinski’s sign

69
Q

What does babinski’s sign test for

A

Upper motor neuron lesion

70
Q

Normal response to babinski:

Abnormal response:

A

Normal- toe flexion or no response

Abnormal- big toe extension, other digits abduction

71
Q

What test is this:

Flick the nail on the 3rd or 4th finger. A positive response is seen in flexion of terminal phalanx of the thumb

A

Hoffman’s sign

72
Q

What does Hoffman’s sign test for

A

Problems in the corticospinal tract

NMS Diagnosis (3 decks)

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